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Results for “Health Services Misuse”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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At least 19 recordsLinked to original sources
PubMed1992

Primary care in accident and emergency and general practice: a comparison.

This paper reviews the way in which literature describing 'inappropriate' attenders at Accident and Emergency (A & E) departments in Britain has suggested that they could be provided for in General Practice and that their attendance at A & E departments therefore implies a 'failure' of general practice in urban areas. One problem with much previous research is that 'inappropriate' attenders have been retrospectively identified. The comparative survey of attenders at a London A & E department and patients visiting their GP in the same district reported here prospectively identified A & E attenders with primary care problems and examined the differences between them and the GP attenders. Patients attending the hospital A & E department were similar to the GP attenders in terms of socio-economic indicators, but had problems which were not typical of the general practice workload and were in different circumstances. The results suggest that there will be a continuing demand for hospital-provided primary care in urban areas, and that attempts to deflect such care to the community will meet with limited success.

Adolescent↗
PubMed1992

Inappropriate placement of residents in psychiatric nursing homes in Bergen, Norway.

The mental and physical capacities of all residents in psychiatric nursing homes in Bergen were studied. It was found that 95% were moderately or severely mentally impaired and 53% received antipsychotic medication regularly. By objective criteria, 47.9% were considered improperly placed. These patients typically had had a long stay in the institution, were immobile, and were given antipsychotic drugs infrequently.

Activities of Daily Living↗
PubMed1992

Assigning appropriateness ratings for diagnostic upper gastrointestinal endoscopy using two different approaches.

Methods that combine information in the medical literature with expert clinical judgment are needed to determine the appropriateness of use of a procedure. The purpose of this study is to better understand the reliability and construct validity of this process by comparing ratings of appropriateness for diagnostic upper gastrointestinal endoscopy that were developed using different approaches by two independent groups. Both the RAND/UCLA Health Services Utilization Study (HSUS) and the American Society for Gastrointestinal Endoscopy (ASGE) combined scientific data with expert physician judgment to rate the appropriateness of specific clinical indications for the use of upper gastrointestinal endoscopy. This study applies the ratings developed by each group to a nationally representative sample of 1,585 endoscopies performed on people 65 years of age and older in 1981. HSUS developed indications that could be used to rate all 1,585 procedures; ASGE indications were less comprehensive and applied to 70% (n = 1,115) of procedures. Of those rated by both groups, appropriateness category ratings agreed for 94% of the procedures. However, the procedures not rated by ASGE were unevenly distributed across HSUS appropriateness ratings. Twelve percent of procedures rated as appropriate by HSUS were not rated by ASGE, but 80% of procedures rated as equivocal by HSUS and 73% rated as inappropriate by HSUS were not rated by ASGE, for those procedures rated by both approaches there was good agreement; however, a more explicit and comprehensive method may be required if equivocal and inappropriate use of a procedure is to be identified.

Aged↗
PubMed1992

Reducing older patients' reliance on the emergency department.

Older adults tend to avoid mental health services and rely on hospital emergency departments for medicalization of these conditions. An intervention was designed for use in emergency departments to refer older adult patients with mental and social health problems to appropriate services within the hospital and community. Most of the patients in the study used the services to which they were referred; further, the intervention was found to decrease repeat utilization of the emergency department. Social work practice and policy implications of the findings are also discussed.

Aged↗
PubMed1978

Curbing the nation's appetite: the case for controlling demand.

For too long, controls have been placed on the costs of services, the construction of health care facilities, the numbers and kinds of providers, and the health insurance industry with no concomitant limits being set on the rising demand for capital-intensive and specialized services. If we are to avoid having a debilitated health care system that will be unable to respond to community needs, the author says, a more balanced approach in controlling supply and demand will have to be sought. He discusses some of the conceptual, technical, and operational problems that must be addressed immediately if these actions are to be successful.

Delivery of Health Care↗
PubMed1978

Physician responsibility for the cost of unnecessary medical services.

Most diagnostic and therapeutic services are ordered by physicians, but physicians practicing under fee-for-service conditions have few incentives to contain the costs of medical care. Without such incentives, effective cost control through mechanisms such as Professional Standards Review Organizations have been disappointing. Several legal approaches might be used to increase physicians' responsibility for the cost of unnecessary services--expansion of tort law, implied contact, redesign of insurance mechanisms, equitable estoppel and informed consent. However, increasing physician responsibility will require uniform but flexible definitions of medical necessity, reliable means for predeterming the need for services and effective penalties or incentives. We propose a peer-review system that would incorporate the sharing of financial risk among physician, hospital, insurer and patient in the fee-for-service sector.

Costs and Cost Analysis↗
PubMed1977

Control of fraud and abuse in Medicare and Medicaid.

This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.

Crime↗
PubMed1979

Royal Commission.

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Evaluation Studies as Topic↗
PubMed1977

Measures of emergency ambulance effectiveness: unmet need and inappropriate use.

For Health Systems Agencies to fulfill their needs assessment and facility regulation functions under the National Health Planning and Resources Development Act of 1974 (PL 93-641), process measures are needed to evaluate the overall efficiency of an emergency ambulance system. In Erie County, New York, unmet ambulance need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 55%. Inappropriate ambulance use, defined as the proportion of emergency patients receiving ambulance care who did not clinically need it, was found to be 30%. These two measures were cross-tabulated with patient and visit characteristics to identify the determinants of unmet need and inappropriate use and to generate recommendations for system changes to reduce both types of ambulance ineffectiveness.

Adolescent↗
PubMed1992

Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians.

BACKGROUND: There is widespread concern that ownership by physicians of testing or treatment facilities to which they refer patients leads to overuse of such facilities. We determined the patterns of use of three services--physical therapy, psychiatric evaluation, and magnetic resonance imaging (MRI)--among physicians treating patients whose care was covered under workers' compensation. We then compared the rates of use among physicians who referred patients to facilities of which they were owners (self-referral group) with the rates among physicians who referred patients to independent facilities (independent-referral group). METHODS: We used a large data base to analyze claims under workers' compensation in California from October 1, 1990, through June 30, 1991, to determine the frequency and cost of these three selected services and determined whether the referring physicians were practicing self-referral or independent referral. We evaluated the cost per case for all three services, measured the frequency with which physical therapy was initiated, and evaluated the medical appropriateness of MRI. RESULTS: We found that physical therapy was initiated 2.3 times more often by the physicians in the self-referral group (68 percent) than by those in the independent-referral group (30 percent; P < 0.01). The mean cost per case for physical therapy was significantly lower in the self-referral group ($404 +/- 102) than in the independent-referral group ($440 +/- 167; P < 0.01). The mean cost of psychiatric evaluation services was significantly higher in the self-referral group than in the independent-referral group (psychometric testing, $1,165 +/- 728 vs. $870 +/- 482; P < 0.01, psychiatric evaluation reports, $2,056 +/- 1,063 vs. $1,680 +/- 578; P < 0.01). The total cost per case of psychiatric evaluation services was 26.3 percent higher in the self-referral group ($3,222 +/- 1,451) than in the independent-referral group ($2,550 +/- 742; P < 0.01). Of all the MRI scans requested by the self-referring physicians, 38 percent were found to be medically inappropriate, as compared with 28 percent of those requested by physicians in the independent-referral group (P < 0.05). There was no significant difference in the cost per case between the two groups. CONCLUSIONS: This study demonstrates that self-referral increases the cost of medical care covered by workers' compensation for each of the three types of service studied.

Ambulatory Care Facilities↗
PubMed1978

Third-party payers: to pay or not to pay.

Insurance companies have traditionally been wary of providing coverage for mental illness for two reasons: 1) they fear that people would bring a mental illness on themselves or would use treatment for self-actualization, and 2) they fear the risk of providing never-ending treatment for "incurable" illness. The author states that the insurers' fears are groundless but suggests that psychiatrists research the utilization and costs of their treatments in insurance plans collaboratively with the actuaries who determine policy and premiums. Retrospective and prospective criteria for outcome and effectiveness of psychiatric treatment must be developed and applied.

Attitude of Health Personnel↗
PubMed1992

Potential conflicts of interest in the delivery of medical services: an analysis of the situation and a proposal.

One health care issue that has gained recent public and professional attention is that of professional conflicts of interest with regard to financial incentives to either withhold possibly necessary services or perform unnecessary ones. This essay explores the evidence bearing on the issue, interprets published information, and proposes a solution to deal with the issue.

Conflict of Interest↗
PubMed1992

Whither medicine?

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Delivery of Health Care↗